The involvement of the sympathetic nervous system in tetanus

Hörtnagl, Heide; Brücke, T.; Hackl, J. M.

doi:10.1007/bf01480476

Cited by 14 publications

(7 citation statements)

References 45 publications

(100 reference statements)

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“…Arrhythmias and cardiac failure are often associated with sudden death in patients with tetanus. Elevated catecholamine levels in plasma and urine have been found in several patients with tetanus who developed these symptoms, as well as prolonged overactivity of the sympathetic nervous system [71]. In 20 consecutive male patients admitted with tetanus, sinus tachycardia was present in 85% (17) patients, prolonged QT-interval in 60% (12) patients, non-specific ST-T abnormalities in 60% (12) patients and P-wave changes in 50% (10) patients.…”

Section: The Spqrsta As Marker Of Repolarization Heterogeneity In Arrmentioning

confidence: 99%

The Spatial QRS-T Angle: Implications in Clinical Practice

Voulgari

Pagoni²,

Tesfaye³

et al. 2013

CCR

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The ventricular gradient (VG) as a concept was conceived in the 1930s and its calculation yielded information that was not otherwise obtainable. The VG was not utilized by clinicians at large because it was not easy to understand and its computation time-consuming. The contemporary spatial QRS-T angle is based on the concept of the VG and defined as its mathematical and physiological integral. Its current major clinical use is to assess the cardiac primary repolarization abnormalities in 3-dimensional spatial vectorial plans which are normally untraced in the presence of secondary electrophysiological activity in a 2-dimensional routine electrocardiogram (ECG). Currently the calculation of the spatial QRS-T angle can be easily computed on the basis of a classical ECG and contributes to localization of arrhythmogenic areas in the heart by assessing overall and local heterogeneity of the myocardial ventricular action potention duration. Recent population-based studies suggest that the spatial QRS-T angle is a dominant ECG predictor of future cardiovascular events and death and it is superior to more conventional ECG parameters. Its assessment warrants consideration for intensified primary and secondary cardiovascular prevention efforts and should be included in everyday clinical practice. This review addresses the nature and diagnostic potential of the spatial QRS-T angle. The main focus is its role in ECG assessment of dispersion of repolarization, a key factor in arrythmogeneity.

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Section: The Spqrsta As Marker Of Repolarization Heterogeneity In Arrmentioning

confidence: 99%

The Spatial QRS-T Angle: Implications in Clinical Practice

Voulgari

Pagoni²,

Tesfaye³

et al. 2013

CCR

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“…Arrhythmias are observed in tetanus patients, especially in the more severe forms, hypercatecholaminemia being the highest risk factor 1,3,7,8,10,15,27 . This study detected a low frequency of arrhythmias of clinical relevance and, unlike what was expected, there was no difference when we compared the presence of arrhythmia in general either between Groups A and B or between patients with and without sympathetic overactivity detected by 24 hours electrocardiographic (Holter) monitoring.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, with the advent of more effective control and prophylaxis of respiratory complications in intensive care units (ICU), formerly the main cause of death (61 to 80%) 1,3,4 , the effects of tetanus on the cardiovascular system have been observed and seem to cause increasing morbidity and mortality in these patients 5,7,8,18,21,26 .…”

Section: Introductionmentioning

confidence: 99%

“…The cardiovascular manifestations of tetanus consist of disturbances of heart rate and rhythm, blood pressure instability, arrhythmias, myocardial dysfunction and sympathetic overactivity 10,15,20,30 . They may be due to the direct action of the tetanus toxin on the heart, to the drugs used to control rigidity and spasms, and to the hypersympathetic state induced by the failure to inhibit adrenal release of catecholamines 7,8,23,29 .…”

Section: Introductionmentioning

confidence: 99%

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Sympathetic overactivity and arrhythmias in tetanus: electrocardiographic analysis

Filho

Lacerda²,

Albuquerque

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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As a result of the advances in the control of pulmonary insufficiency in tetanus, the cardiovascular system has increasingly been shown to be a determining factor in morbidity and mortality but detailed knowledge of the cardiovascular complications in tetanus is scanty. The 24h-Holter was carried out in order to detect arrhythmias and sympathetic overactivity in 38 tetanus patients admitted to an ICU. The SDNN Index (standard deviation from the normal R-to-R intervals), was useful in detecting adrenergic tonus, and ranged from 64.1 +/- 27 in the more severe forms of tetanus to 125 +/- 69 in the milder ones. Sympathetic overactivity occurred in 86.2% of the more severe forms of the disease, but was also detected in 33% of the milder forms. Half the patients had their sympathetic overactivity detected only by the Holter. The most frequent arrhythmias were isolated supraventricular (55.2%) and ventricular (39.4%) extrasystoles. There was no association of the arrhythmias with the clinical form of tetanus or with the presence of sympathetic overactivity. The present study demonstrated that major cardiovascular dysfunction, particularly sympathetic overactivity, occurs in all forms of tetanus, even in the milder ones. This has not been effectively detected with traditional monitoring in ICU and may not be properly treated.

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“…The well‐described symptoms of somatomotor pathology are painful spasms of the face, neck, limbs, and back (Bleck, 1989). Generally, symptoms of autonomic pathology are manifestations of sympathetic hyperactivity, which include tachycardia, hypertension, and an elevated metabolic rate (Hörtnagl and Brücke, 1979; Bleck, 1989; Wright et al, 1989).…”

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confidence: 99%

Ultrastructural localization of the binding fragment of tetanus toxin in putative ?-aminobutyric acidergic terminals in the intermediolateral cell column: A potential basis for sympathetic dysfunction in generalized tetanus

et al. 2000

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Tetanus toxin (TeTx) causes sympathetic hyperactivity, a major cause of mortality in generalized tetanus, apparently by obstructing the inhibition of sympathetic preganglionic neurons (SPNs). Neuroanatomic tracing and immunohistochemistry were used to investigate whether axon terminals in the intermediolateral cell column (IML) that synapse on SPNs and use the inhibitory neurotransmitter γ‐aminobutyric acid (GABA) may be infected transsynaptically with TeTx. The binding fragment of TeTx (TTC; an atoxic surrogate of TeTx) and the cholera toxin B subunit (CTB; a retrograde tracer) were injected into the rat superior cervical ganglion and, over 16–48 hours, were transported to the ipsilateral IML in the caudal half of the last cervical and first three thoracic spinal cord segments. With light microscopy, diffuse CTB immunolabeling extended throughout SPN perikarya and dendrites. Punctate TTC and GABA immunolabeling were accumulated densely in the neuropil between and surrounding SPN processes. With electron microscopy, 54% of the axon terminals in the IML (n = 1,337 terminals) were TTC immunolabeled (TTC+), and 25% contained putative neurotransmitter levels of GABA immunolabeling (GABA+). On average, GABA+ terminals had a 76% chance of also being TTC+ and a 62% greater chance of being TTC+ than GABA− terminals (P < 0.000001). Axon terminals were just as likely to be TTC+ and/or GABA+ regardless of whether the dendrites they synapsed on were large (>1 μM) or small in cross‐sectional area or were labeled retrogradely. Sympathetic hyperactivity in tetanus may involve 1) retrograde and transsynaptic transport of TeTx by SPNs and 2) at least in part, an infection of GABAergic terminals in the IML. J. Comp. Neurol. 419:471–484, 2000. © 2000 Wiley‐Liss, Inc.

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The involvement of the sympathetic nervous system in tetanus

Cited by 14 publications

References 45 publications

The Spatial QRS-T Angle: Implications in Clinical Practice

The Spatial QRS-T Angle: Implications in Clinical Practice

Sympathetic overactivity and arrhythmias in tetanus: electrocardiographic analysis

Ultrastructural localization of the binding fragment of tetanus toxin in putative ?-aminobutyric acidergic terminals in the intermediolateral cell column: A potential basis for sympathetic dysfunction in generalized tetanus

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